Legion challenges VA claims accuracy

Zachary Hearn, deputy director of benefits for the Legion, appeared before the House Veterans’ Affairs subcommittee on disability and memorial affairs on Dec. 4.

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The American Legion testified at a Dec. 4 hearing on Capitol Hill that examined VA’s track record in processing complex disability claims that deal with conditions such as traumatic brain injury (TBI), post-traumatic stress disorder (PTSD) and military sexual trauma (MST).

Zachary Hearn, deputy director of benefits for the Legion, appeared before the House Veterans’ Affairs subcommittee on disability and memorial affairs; he also submitted written testimony for the record.

The American Legion challenged the accuracy of online statistics from VA’s Monday Morning reports, claiming they were not consistent with the Legion’s review of recently adjudicated claims; of 260 claims examined, 55 percent contained errors. “This statistic is in stark contrast to the approximate 90 percent accuracy rating in claims adjudication indicated by (VA),” the Legion stated.

According to VA data, Hearn noted, the Nashville VARO had a 95.1 percent accuracy rating for the previous three months. Yet when American Legion experts reviewed 22 of the claims, they found seven with errors. “Our review paints a far dimmer picture of Nashville’s accuracy than indicated in the Monday Morning Workload Report,” Hearn said.

Lauren Price, a retired Navy petty officer and representative of Veteran Warriors, told the subcommittee that the Department of Veterans Affairs “is not doing business properly. I could sit here for hours and give you statement(s) of egregious behavior, wrongful denials - in some cases, deliberate malfeasance.” She asked Congress to press forward in its VA oversight and support her organization’s mission, “which is to have a full overhaul of the (VA), completely reorganizing the way they’re doing business, and demanding full and 100 percent accountability and repercussions for their actions.”

Another witness, Bettye McNutt, described how she submitted a benefits claim 23 years ago that VA continues to deny, despite expert medical opinions that her late husband, a Vietnam War veteran, died of cancer “that was, as likely as not” linked to Agent Orange exposure.

Price, when asked to identify the most frequent errors in the VA claims process, said, “Failure to apply the law correctly, complete disregard of medical evidence provided - most specifically, from civilian providers, and ... the almost complete and utter disregard for anything that is considered a policy, rule, regulation or law.”

Price noted an April 26, 2010 VA policy change on disability claims related to burn-pit exposure (as in her own case). The application of that policy change by VA regional offices (VAROs), she said, “has, to the best of my knowledge, not been addressed once in the almost 5,000 victims I know personally.”

Ronald Abrams, joint executive director for the National Veterans Legal Services Program, told the subcommittee that VA’s error rate for complex disability claims has increased. “You just simply can’t go too fast when you have complicated claims - special monthly compensation, traumatic brain injury. In fact, the regulation dealing with TBI is so complicated that some people call it the ‘Da Vinci Code.’”

Sometimes, Hearn said, VA doesn’t seem to know when to stop, “and over-complicates a claim.” He referred to a case from the VARO in Reno, Nev., which required two medical examinations to establish service connection to a veteran’s PTSD “when only one was necessary, and it took over two years from the date of the first examination to adjudicate the claim, and then another four months to notify the veteran.”

When complex benefits claims are made even more difficult by VA errors, Abrams said, “The veterans face a nightmare. Not only do they have to get the right evidence before the VA, they have to overcome the unfair denial, which is an obstacle that stands in their path.”

Abrams said the worst type of VA errors are the result of adjudications made too quickly. “Some VAROs incorrectly adjudicate and prematurely deny claims based on inadequate evidence - especially inadequate VA exams. These errors reveal for many veterans that the claims process can be adversarial.”

Abrams’ experience includes participation in more than 40 Regional Office Action Reviews conducted by The American Legion, “who should be commended for doing that work.” Such reviews showed him that VA’s error rate “has been consistently at least 30 percent in the various (regional offices). Sometimes it’s higher. It’s unrealistic to assume that the VA will ever get its real (accuracy) rate to 98 percent.”

VA has a “gold mine” of data to help improve the accuracy of its workers, the Legion testified, in the Veterans Benefits Management System, decisions of the Court of Appeals for Veterans Claims, the Appeals Management Center and the Board of Veterans Appeals. Yet, “this gold mine remains untapped. The American Legion would like to see VA develop a system to analyze the vast trove of error information, track it, and use it to develop training to improve results.”

Putting the claims accuracy issue into proper perspective, Hearn told the subcommittee that the difference between VA’s stated goal of 98 percent accuracy “and even 97 percent is over 10,000 veterans who may not get the benefits they earned.... That is why The American Legion is constantly raising the importance of accuracy. Because for all those veterans who wind up on the wrong end of those errors - VA’s accuracy rate may as well be zero.”

Hearn said that VA needs to adopt strategies articulated by National Commander Daniel M. Dellinger during his Oct. 3 congressional testimony: fix a work-credit system “that currently places more emphasis on actions completed than actions done right,” and aggregate common errors “to develop a training plan - these are steps we want to see taken.”

According to a February 2013 Congressional Research Service (CRS) report, about 384,000 servicemembers have been diagnosed with TBI or PTSD from 2000 to 20012. The Associated Press reported last May that, in 2012, more than 85,000 veterans sought treatment for injuries or diseases caused by MST.

More in Veterans Benefits Center

Carroll Johnson

Jan.30,2015
Plei-Ku 1965,Woke up each morning with ears full of AO saturated dust.Retired 1970 not realizing the price that I would pay as I became older,Heart Attack six years after leaving Nam than starting to lose fealing in my feet and legs which became so numb that I had trouble maintaining balance in the dark or with my eyes closed.None of these conditions listed on my medical records so that left me out in the cold as far as V A was concerned.
In 2005 after AO exposure was linked to both Heart and Diabetes I was granted a whopping 20% Disability for Diabetes and 40% for neuropathy each leg.Asked for and received V A exam 06 and found that my leg condition was much worse but no increase above the 40%.
2010 asked again for increase above 40% with Docters statement severe neuropathy in legs and feet but no persentage increase.V A exam by QTC in July 14 was lost by V A or was never sent by QTC.Some RO must have rated me without an exam for guidance, gave me several ratings which did not change my pay status than denied any increase in the 40% on my legs.
So here I sit on the three wheel scooter that I have used for two years in order to be mobile in my home that is not compatable for a wheelchair.
I can not help but believe that I have been denied LOU of feet simply because of the jump in rating that it would cause and also the fact that I could apply for a grant that would make my home wheelchair accessable.

David Davis

I think it is apparent that this agency is full of BS and corruption from top to bottom. It is not pro veteran by any means. It is pro bank and pro delay deny and wait till I and all veterans die laws.
It is funded by our corrupt congress and overseen by our corrupt president.

Bob Hemmes

Being retired military and receiving a VA disability, (to quote a biblical proverb) my disability check is taken from Peter to pay Paul, so I really do not get a real disability check just money is taken from one pocket and placed in another. When I first was granted a disability check it was a thousand dollars because the claim took over a year to approve and they paid me for back monies for that year but they also paid me the monthly check. Knowing that I could not keep both, I was advised by the VA to send back the check with an explanation. A month later my wife received a letter from the VA offering their condolences for my DEATH.
Apparently according to the VA then only reason to send a disability check back was because of the death of the disabled vet. To make matters worse since I was DEAD they stopped my disability checks and it took two congressman and a personal letter assuring the VA that indeed I was still alive to get the VA to reinstate my checks 3 months later. To quote Forrest Gump "STUPID IS AS STUPID DOES

wanc848+

My thanks to the American Legion and Senator Burr for challenging VA's reported accuracy figures. I found Ms. Hickey's testimony very interesting, particularly this statement “It’s an apples-and-orange(s) discussion, if I may have a moment to clarify that,” Hickey said. “First of all, let me just state for the record ... we will not trade production for quality". As an ex-employee, I can tell you, production ALWAYS was first priority. Quality was given a lot of lip service, but never trumped production. This was stressed daily by Management at every level. If you look further, you might be amazed at what you discover.

Elpidio M. Osteria

It is very frustrating to deal with the VA specially the adjudicating department. I filed my cases in August of 2009 at the San Diego Regional Office. In spite of the preponderance of medical evidences, they had decided to lo ball my level of disabilities after waiting for 2 years. I filed a Notice of Disagreement and waited for a year for them to make a decision. On the second year I filed for a Writ of Mandamus to compel them to make a decision on my case. To my amazement, the government counsel in collusion with the rating officer decided to deny my request for a higher level of Aid and Attendance. As the common saying goes, you catch a fish through his mouth. Low and behold that when they published the Statement of my Case, they made statement to the effect that on account of the lost of functions of feet, I am entitle to a higher level of aid and Attendance and that is under letter M. What is more fascinating is there lack of initiative to correct the errors and instead pass my case to the Veterans Board of Appeals. Previously they awarded me Special Compensation under letter K but there are no accompanying compensation that should go with it. They also failed to implement the COLA of 1.7% for the year 2013 and it took them more than 6 months to correct this but not till my Congresswoman intervene. This is how dysfunctional the VA is and they had very good when it comes to media propaganda to mislead the public. Thank you to the American Legion for taking the cudgel and keep up the good work.

Allen Noble

My original claim was in 1992 for cervical strain, Hemmoriods, corporal tunnel, Knee problems, Lower back pain. I received 40% for the lower back, Knees and Cervical strain. This happened within six months after my exam. I left VA alone for over 15 years then things started to go down hill. My lower back pain moved into my hips and my Knees started giving out so I applied with the supervision of a VSO for connection of my hips. I received connection for the hips but no comprehension. I appealed in 2010. I am still waiting to see the DSO witch I requested to see. I have received nothing indicating that the Va is even working on it. I keep checking e-benefits and see no progress. In the meantime have sent much evidence to support the claim. Last time We sent evidence to support the claim the VA turned it into a claim. They closed it out as a denial. The main problem is that my condition has gone down hill in the meantime and I am wheel chair bound and my cervical strain has worsen to where my ROM is less then 30%.I am still waiting for a discision on my appeal and in the meantime am loosing money and support every month. The congress now is looking to stop a lot of benefits now so please people write you reps on the hill and tell them how disappointed you are. Make this not happen!!~~
worse
ten to my ROM has decreased to less then 30

Bill millholen

I am AO exposed Nam vet, VA gave me surgery. DBS for Parkinson's. Marines lost my records repeatedly.
First attack in 1974, went to long beach VA. Nothing wrong of course. Applied Reno VA 20053UK and treated fine there until surgery Ft Miley SF. Finest hospital and staff ever. Applied for disability 2004, they lost those, applied again this June and ? Not a combat Marine, served 18 months Okinawa. TAD several trips to Nam.
I get all this wonderful VA care and the DOD can't pay compensation now? I worry for the guys coming home now.
GET YOUR MED RECORDS NOW, ON PAPER. SOMEDAY YOULL NEED EM,

Lorraine winlass

Accuracy-- from the American Legion you can depend on it as they process vets' claims every day. Slow results from the VA? You can depend on it! Government corruption? The VA is the model for healthcare under federal control. On steroids since so many millions more will depend on insurance to function. Be prepared Americans, to pay cash and wait for reimbursements 2 years later! If the insurance industry survives. We are betting they declare bankruptcy like we had to . . .

William Trayer

I filed my original claim in 2010. My case was decided 2 yrs later, but the write-up was inaccurate as were some of the things I should have been approved for were disapproved. I filed an NOD, 6 months ago and have heard nothing, not to mention they took my entire disability check until my Navy severance that I received 30+ yrs ago, is paid back which will be May 14. How am I supposed to live?